Prevalence of CKD and Comorbid Illness in Elderly Patients in the United States: Results From the Kidney Early Evaluation Program (KEEP) (original) (raw)
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International Journal of Research in Medical Sciences, 2016
from the dual medical conditions; where age-related declined immunity and physiological changes has led to an increased burden of communicable diseases as well as non-communicable chronic diseases. Equally, defining aging is problematic, and each expert in the field will have his or her own version. We believe that aging is the consequence of two associated, but not identical, processes: the decline in function and the ABSTRACT Background: Chronic kidney disease (CKD) has become a major issue in our nation. CKD does not have a specific target, but individuals with diseases such as diabetes mellitus, cardiovascular disease, and obesity are all at increased risk. The chronic kidney disease (CKD) is associated with many features like hyperkalemia, hypocalcemia, hyponatremia, anaemia, hypoalbuminemia, high blood pressure etc. So if we detect all these features early, we can extend the quality life of CKD patients. Aim and objectives of the study were early detection of CKD in elderly people at Initial stage to prevent progression of disease, to study the clinical and biochemical profile and comorbidities in elderly people with CKD. Methods: This Hospital based descriptive study was done in the Department Of Medicine, NSCB Medical college, Jabalpur from October 2014 to October 2015 including 100 patients of 60+ years of age. Results: In present study the etiology of chronic kidney disease was diabetes in 45.0%, hypertension in 38.0%, obstructive uropathy in 8.0% and undetermined etiology was 9.0%. Cardiovascular disease was present in 28% cases, stroke in 22% cases. Most common clinical features was dyspnoea [63.0% (p<0.001)] pedal oedema (31%), high blood pressure [54.0% (p<0.001)], pallor [49.0% (p<0.001)], and pedal oedema (31.0%).The abnormality in the laboratory profile was dyslipidemia in 73% hypoalbuminemia in 31.0% (p<0.05), albuminuria in 73.0% (p<0.001), hypocalcemia in 54.0% (p<0.001), hyponatremia in 23.0%, hyperkalemia in 14%, anemia in 60.0% (p<0.05). LVH on echocardiography is present in 34.0% (p<0.05) cases. Conclusions: The major causes of CKD in descending order were, type 2 diabetes mellitus, hypertension, and obstructive uropathy. All these features needs prompt detection and correction at earlier stages of CKD to delay progression and reduce associated morbidity and exacerbating factors and to prevent early mortality.
Chronic kidney disease in the elderly; a silent epidemic
Irish medical journal, 2005
Chronic kidney disease has been shown to be associated with significant increases in mortality and morbidity even in early stages. Despite this it is rarely diagnosed, actively investigated or managed in the elderly. We set out to establish the prevalence of CKD and identify causative factors in a consecutive series of referrals to a geriatric medical clinic. We calculated glomerular filtration rates (GFR) for 101 patients attending a geriatric medical clinic using the Cockroft and Gault formula, and collected data on medications and relevant past medical history. Mild CKD (GFR <60ml/min) was present in 80% of the group. Only 10% of these patients had serum creatinine >130(mmol/L. hypertension was present in 50% and only 9% were diabetic. Almost one third were on inappropriate drugs or dosages; most commonly non-steroidal anti-inflammatory drugs (99%). Chronic kidney disease is extremely common in older people attending a geriatric medical clinic and carries significant risks....
Advances in Chronic Kidney Disease, 2010
The world's population is aging, with the number of older adults projected to increase dramatically over the next two decades. This trend poses major challenges to health care systems, reflecting the greater healthcare utilization by and more comorbid conditions among elderly adults. Chronic kidney disease (CKD) is a substantial concern in the elderly, with both an increasing incidence of treated kidney failure with dialysis as well as a high prevalence of earlier stages of CKD. Given the high burden of risk factors for CKD, the high prevalence of CKD in the elderly is not surprising, with the rise in obesity, diabetes and hypertension in middle-aged adults likely foreshadowing further increases in CKD prevalence among the elderly. It is now commonly agreed that the presence of CKD identifies a higher risk state in the elderly, with increased risk for multiple adverse outcomes, including kidney failure, cardiovascular disease, cognitive impairment, and death. Accordingly, CKD in older adults is worthy of attention by both health care providers and patients, with the presence of a reduced GFR or albuminuria in the elderly potentially informing therapeutic and diagnostic decisions for these individuals.
Nephrology Dialysis Transplantation, 2011
Background. Little is known about normal kidney function level and the prognostic significance of low estimated glomerular filtration rate (eGFR) in the elderly. Methods. We determined age and sex distribution of eGFR with both the Modification of Diet in Renal Disease (MDRD) study and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in 8705 community-dwelling elderly aged !65 years and studied its relation to 6-year mortality. In a subsample of 1298 subjects examined at 4 years, we assessed annual eGFR decline and clinically relevant markers including microalbuminuria (3-30 mg/mmol creatinine) with diabetes, proteinuria !50 mg/mmol, haemoglobin <11 g/L or resistant hypertension despite three drugs. Results. Median (interquartile range) MDRD eGFR was 78 (68-89) mL/min/1.73m 2 in men and 74 (65-83) in women; http://ndt.oxfordjournals.org/ Downloaded from there were 79 (68-87) and 77 (67-85) for CKD-EPI eGFR, respectively. Prevalence of MDRD eGFR <60 mL/min/ 1.73m 2 was 13.7% and of CKD-EPI eGFR was 12.9%. After adjustment for several confounders, only those with an eGFR <45 mL/min/1.73m 2 had significantly higher allcause and cardiovascular mortality than those with an eGFR of 75-89 mL/min/1.73m 2 whatever the equation. In the subsample men and women with an MDRD eGFR of 45-59 mL/min/1.73m 2 , 15 and 13% had at least one clinical marker and 15 and 3% had microalbuminuria without diabetes, respectively; these percentages were 41 and 21% and 23 and 10% in men and women with eGFR <45, respectively. Mean MDRD eGFR decline rate was steeper in men than in women, 1.75 versus 1.41 mL/min/1.73m 2 /year. Conclusions. Moderately decreased eGFR is more often associated with clinical markers in men than in women. In both sexes, eGFR <45 mL/min/1.73m 2 is related to poor outcomes. The CKD-EPI and the MDRD equations provide very similar prevalence and long-term risk estimates in this elderly population.
CKD and Hospitalization in the Elderly: A Community-Based Cohort Study in the United Kingdom
American Journal of Kidney Diseases, 2011
Background: We previously have shown that chronic kidney disease (CKD) is associated with cardiovascular and all-cause mortality in community-dwelling people 75 years and older. The present study addresses the hypothesis that CKD is associated with a higher rate of hospital admission at an older age. Study Design: Cohort study. Setting & Participants: 15,336 participants from 53 UK general practices underwent comprehensive health assessment between 1994 and 1999. Predictor: Data for estimated glomerular filtration rate (eGFR, derived from creatinine levels using the CKD Epidemiology Collaboration [CKD-EPI] study equation) and dipstick proteinuria were available for 12,371 participants. Outcomes: Hospital admissions collected from hospital discharge letters for 2 years after assessment. Measurements: Age, sex, cardiovascular risk factors, possible biochemical and health consequences of kidney disease (hemoglobin, phosphate, and albumin levels; physical and mental health problems). Results: 2,310 (17%) participants had 1 hospital admission, and 981 (7%) had 2 or more. After adjusting for age, sex, and cardiovascular risk factors, HRs were 1.66 (95% CI, 1.21-2.27), 1.17 (95% CI, 0.95-1.43), 1.08 (95% CI, 0.90-1.30), and 1.11 (95% CI, 0.91-1.35) for eGFRs Ͻ30, 30-44, 45-59, and Ն75 mL/min/1.73 m 2 , respectively, compared with eGFRs of 60-74 mL/min/1.73 m 2 for hospitalizations during Ͻ6 months of follow-up. HRs were weaker for follow-up of 6-18 months. Dipstick-positive proteinuria was associated with an increased HR throughout follow-up (HR, 1.29 [95% CI, 1.11-1.49], adjusting for cardiovascular risk factors). Dipstick-positive proteinuria and eGFR Ͻ30 mL/min/1.73 m 2 were independently associated with 2 or more hospital admissions during the 2-year follow-up. Adjustment for other health factors and laboratory measurements attenuated the effect of eGFR, but not the effect of proteinuria. Limitations: Follow-up limited to 2 years, selection bias due to nonparticipation in study, missing data for potential covariates, and single noncalibrated measurements from multiple laboratories. Conclusions: The study indicates that community-dwelling older people who have dipstick-positive proteinuria and/or eGFR Ͻ30 mL/min/1.73 m 2 are at increased risk of hospitalization.
Chronic kidney disease in the elderly - assessment and management
Australian family physician, 2012
A reduction in estimated glomerular filtration rate (eGFR), and/or the presence of proteinuria, are the predominant manifestations of chronic kidney disease (CKD), which is common in the elderly population. This article outlines the clinical significance of CKD in the elderly and summarises recently updated recommendations for its assessment, staging and management. Most elderly patients with CKD present asymptomatically. Despite this, it is clinically significant as it is one of the most potent risk factors for cardiovascular disease. Even modest reductions in eGFR are associated with an increased prevalence of CKD-related complications such as anaemia and hyperphosphataemia. Early detection is an important strategy and should include all three components of the kidney health check (blood pressure measurement, a blood test for serum creatinine and eGFR, and a urine test for albumin:creatinine ratio). Treatment is guided by the patient's stage of CKD, based on kidney function (e...
Aging Clinical and Experimental Research, 2021
Background Chronic kidney disease (CKD) is a common condition in older people and represents a global health issue since it increases the risk of associated comorbidities and all-cause mortality. Furthermore, older people with reduced renal function might be at higher risk for developing functional limitation and disability. Moreover, the current creatinine-based measures of renal function are influenced by several factors in older population. The aims of the CKD-3D project are to perform an observational study to expand the knowledge about CKD-disability relationship and to investigate the use of novel biomarkers of kidney function. Methods An observational, multicenter, prospective cohort study will be conducted in 75 + old patients consecutively admitted to acute care wards of geriatric medicine at participating hospitals. The study planned to enroll 440 patients undergoing clinical and laboratory evaluations at baseline and after 12 months. Face-to-face follow-up at 6 months and telephone followup at 3 and 9 months will be carried out. Comprehensive Geriatric Assessment (CGA) and the measurement of Cystatin C, Beta-Trace Protein and Beta2-Microglobulin levels will be included. Discussion This study will provide useful information to prevent CKD-related disability by collecting real-life data over 1-year period. The combined approach of CGA and the investigation of innovative existing biomarkers will make it possible to develop new recommendations and guidelines for a patient-centered approach. It is believed that such a study may lead to an improvement of knowledge on CKD in elderly patients and may also have implications in daily clinical practice and in decision-making process.